Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei, University College of Medicine, Seoul, South Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea.
Front Endocrinol (Lausanne). 2022 Jun 17;13:880164. doi: 10.3389/fendo.2022.880164. eCollection 2022.
Glucagon-like peptide 1 (GLP-1) receptor agonists have demonstrated strong glycemic control. However, few studies have investigated the effects of switching from insulin to GLP-1 receptor agonists. We aimed to investigate, using real-world data, whether switching to dulaglutide improves glycemic control in patients with type 2 diabetes mellitus (T2D) inadequately controlled with conventional insulin treatment.
We retrospectively evaluated 138 patients with T2D who were switched from insulin to dulaglutide therapy. We excluded 20 patients who dropped out during the follow-up period. The participants were divided into two groups according to whether they resumed insulin treatment at 6 months after switching to a GLP-1 receptor agonist (group I) or not (group II). A multiple logistic regression analysis was performed to evaluate the parameters associated with the risk of resuming insulin after replacement with dulaglutide.
Of 118 patients initiated on the GLP-1 receptor agonist, 62 (53%) resumed insulin treatment (group I), and 53 (47%) continued with GLP-1 receptor agonists or switched to oral anti-hypoglycemic agents (group II). Older age, a higher insulin dose, and lower postprandial glucose levels while switching to the GLP-1 receptor agonist were associated with failure to switch to the GLP-1 receptor agonist from insulin.
A considerable proportion of patients with T2D inadequately controlled with insulin treatment successfully switched to the GLP-1 receptor agonist. Younger age, a lower dose of insulin, and a higher baseline postprandial glucose level may be significant predictors of successful switching from insulin to GLP-1 receptor agonist therapy.
胰高血糖素样肽 1（GLP-1）受体激动剂已显示出较强的血糖控制作用。然而，很少有研究调查从胰岛素转换为 GLP-1 受体激动剂的效果。我们旨在使用真实世界的数据，调查对于血糖控制不佳的 2 型糖尿病（T2D）患者，转换用度拉鲁肽是否能改善血糖控制。
我们回顾性评估了 138 例从胰岛素转换为度拉鲁肽治疗的 T2D 患者。我们排除了在随访期间停药的 20 例患者。根据患者在转换为 GLP-1 受体激动剂后 6 个月是否恢复胰岛素治疗（组 I）或未恢复（组 II），将参与者分为两组。采用多因素逻辑回归分析评估与改用度拉鲁肽后恢复胰岛素治疗风险相关的参数。
在开始使用 GLP-1 受体激动剂的 118 例患者中，62 例（53%）恢复胰岛素治疗（组 I），53 例（47%）继续使用 GLP-1 受体激动剂或转换为口服降糖药（组 II）。转换为 GLP-1 受体激动剂时年龄较大、胰岛素剂量较高、餐后血糖水平较低与未能从胰岛素转换为 GLP-1 受体激动剂相关。
相当一部分胰岛素治疗控制不佳的 T2D 患者成功转换为 GLP-1 受体激动剂。年龄较小、胰岛素剂量较低、基线餐后血糖水平较高可能是成功从胰岛素转换为 GLP-1 受体激动剂治疗的重要预测因素。
